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[Display omitted] • The need for safe and controllable anticoagulant drugs is still widely recognized. • Polyionic block copolymers hold great potential for controlling blood clotting. • Attaching neutral blocks to charged copolymers decreases their toxicity. • Safety studies are needed to select promising anticoagulants from block copolymers. Thrombosis is a leading cause of death worldwide, necessitating the search for more effective and safer treatments. Current parenteral anticoagulant medications indicated for the prevention and treatment of thrombosis include polyanionic heparins. Despite their well-established status, these medications have drawbacks and fail to meet the criteria for an ideal anticoagulant. The predictability and control of heparin's biological activity pose challenges due to the chaotic structure of this polymer, characterized by a mixture of larger and smaller molecules with a loosely defined linear architecture. Consequently, cases of heparin overdose are common. Protamine sulphate can halt bleeding caused by unfractionated heparin but concurrently elicits significant adverse effects. Although novel antidotes for anticoagulants have been developed, bleeding during anticoagulation therapy remains a concern. Over the past two decades, research into heparin mimetics has witnessed a significant surge. This intensification is underscored by statistical evidence indicating an increase in thrombotic episodes, highlighting the necessity for new anticoagulant alternatives. This review outlines the efforts to replace heparins and their antidotes with block copolymers. We have concentrated on studies involving well-defined synthetic anionic and cationic block copolymers, which are obtained by free radical polymerization techniques. Block copolymers comprised of anionic poly(sodium 4-styrenesulphonate) or poly(2-acryloylamido-2-methylpropanesulphonic acid) blocks and a neutral poly(ethylene glycol) block seem to be the most promising candidates for future anticoagulants. Complementary polycationic antidotes to regulate anticoagulant activity have also been proposed; however, further research focusing on structure–activity relationships and safety is necessary to confirm their utility. [ABSTRACT FROM AUTHOR]